Data_Sheet_4_The Association Between Impaired Awareness and Depression, Anxiety, and Apathy in Mild to Moderate Alzheimer's Disease: A Systematic Review.PDF

Objectives: Impaired awareness of cognitive and functional deficits is a common feature of Alzheimer's disease (AD). Although a lack of awareness has been suggested to be a protective factor against experiencing affective symptoms, such as depression, anxiety, and apathy which are common in AD, there is conflicting evidence about the links between them. This systematic review examines the evidence for an association between impaired awareness and depressive, anxiety, and apathy symptoms in mild to moderate AD.
Method: We searched four databases (OvidMedline, Embase, PsycInfo, and PsycArticles) using terms encompassing awareness, apathy, depression, anxiety, and mild-moderate AD. We included studies that assessed the relationship between awareness and depressive symptoms, anxiety symptoms, or apathy. We assessed included papers for quality and report results using a narrative approach, prioritizing high quality studies.
Results: We identified 1,544 articles, and twenty-seven studies fulfilled inclusion criteria (high-quality = 15; moderate-quality = 12). Most high-quality studies reported that impaired awareness in early-stage AD is cross-sectionally linked with fewer depressive symptoms and anxiety symptoms (correlation ranged from −0.3 to −0.7), but with more apathy.
Conclusions: High-quality studies suggested that in people with early AD, impaired awareness is related to fewer depressive and anxiety symptoms and to more apathy. Future research should focus on elucidating causality among impaired awareness and these symptoms in AD.

研究目的：认知与功能缺损的自知力受损是阿尔茨海默病（Alzheimer's disease, AD）的常见临床特征。尽管有观点认为，自知力缺乏可能是对抗情感症状的保护因素——这类情感症状在AD患者中颇为常见，包括抑郁、焦虑与淡漠，但二者间的关联证据尚存争议。本系统综述旨在探讨轻中度AD患者中，自知力受损与抑郁、焦虑及淡漠症状之间的关联证据。
研究方法：本研究检索了OvidMedline、Embase、PsycInfo及PsycArticles四个数据库，检索词涵盖自知力、淡漠、抑郁、焦虑及轻中度AD。纳入所有评估自知力与抑郁症状、焦虑症状或淡漠症状之间关联的研究。我们对纳入文献进行质量评价，并采用叙述性方法报告研究结果，优先纳入高质量研究。
研究结果：本次检索共获取1544篇文献，其中27项研究符合纳入标准（高质量研究15项，中等质量研究12项）。多数高质量研究显示，AD早期患者的自知力受损与较轻的抑郁、焦虑症状呈横断面相关（相关系数范围为-0.3至-0.7），但与更严重的淡漠症状呈正相关。
结论：高质量研究表明，在AD早期患者中，自知力受损与更少的抑郁、焦虑症状相关，而与更显著的淡漠症状相关。未来研究应聚焦于阐明AD患者自知力受损与上述症状之间的因果关系。